Online Program

Utilization of Telemedicine to Treat Hepatitis C at a Medication-Assisted Opioid Treatment Program

Wednesday, November 4, 2015 : 12:50 p.m. - 1:10 p.m.

Lawrence S. Brown Jr., MD, MPH, FASAM, START Treatment & Recovery Centers, Brooklyn, NY
Andrew Talal, MD, MPH, Medicine, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY
Marija Zeremski, PhD, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY
Roberto Zavala, MD, START Treatment & Recovery Centers, Brooklyn, NY
Melissa Lin, MS, START Treatment & Recovery Centers, Brooklyn, NY
Anthony Martinez, MD, Medicine, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY
Rositsa Dimova, PhD, Biostatistics, University at Buffalo, SUNY, Buffalo, NY
Bryce Smith, PhD, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
Jon Zibbell, PhD, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
Steven Kritz, MD, START Treatment & Recovery Centers, Brooklyn, NY
Issue: START Treatment & Recovery Centers is an outpatient medication-assisted opioid treatment program that also provides primary medical care. Approximately half of our 3000 largely minority patients are infected with hepatitis C virus (HCV). Very few have accepted HCV treatment to date.  Based on studies showing that co-location of substance abuse treatment with other co-occurring conditions results in improved outcomes for both conditions, we developed a protocol to treat HCV utilizing telemedicine.

Description: It had to be determined whether patients would be interested in on-site treatment. We surveyed 320 patients to determine knowledge level of HCV; asking whether they were receptive to attending educational sessions as a prelude to treatment. The response was overwhelmingly positive, providing impetus to move forward.  We have provided HCV education to all treatment staff and 114 patients.  Fifty patients are HCV infected; of which 23 have had on-site linkage to specialized medical services and evaluation for treatment.  Telemedicine was instrumental in providing these services and evaluations efficiently.

Lessons Learned: Compliance with referral to medical specialists in conventional health care settings is poor. Reasons include fears or doubts, lack of knowledge or interest, and physical limitations. Telemedicine is a simple, cost-effective way to assure timely HCV care, i.e. the hepatologist comes to our clinics (via telemedicine), instead of patients being referred outside.  Preliminary indications are that our approach has been well-received by patients. 

Recommendations: The process of implementing the infrastructure to provide the educational training and telemedicine capabilities presented a number of challenges involving patients, providers, technology, and reimbursement that we have successfully navigated to create a viable model for telemedicine-based delivery of HCV services in a substance use facility.  We expect outcomes (HCV cure rates) to far exceed currently achieved levels for this hard to reach population that is at the epicenter of the HCV epidemic.

Learning Areas:

Chronic disease management and prevention
Clinical medicine applied in public health
Implementation of health education strategies, interventions and programs
Provision of health care to the public

Learning Objectives:
Explain the process by which it was determined that patients would be willing to pursue hepatitis C treatment via telemedicine Identify the internal and external challenges that had to be overcome in order to provide hepatitis C treatment via telemedicine Discuss the status and outcomes for patients in treatment

Keyword(s): Hepatitis C, Telehealth

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Principal Investigator, Chief Executive Officer, and Acting Medical Director at the medication-assisted opioid treatment program where the HCV/telemedicine study is being conducted. Our program provides primary medical care co-located with substance abuse treatment.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.